25D2223588 CLIA NUMBER - MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY03426

Laboratory Demographics

  • CLIA Code: 25D2223588
  • Facility Name: MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY03426
  • Facility Address: 6040 GOODMAN RD
    WALLS, MS
    ZIP 38680
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEON THOMAS
  • NPI Number: 1174798417
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2223588
LAB Type Pharmacy
Facility Name MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY03426
Street 6040 GOODMAN RD
City WALLS
State MS
ZIP 38680
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Pharmacy
Lab Director LEON THOMAS

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This page was last updated on: 9/29/2025